Bibliographic information Overall rating	Study* Category (points deducted)	Practice* Category (points deducted)	Outcome measures* Category (pts deducted)	Results/findings* Category (points deducted)
– Author(s): Christine Schmotzer  – Year: 2011  – Publication: Unpublished  – Affiliations: Case Western Reserve University Hospitals, Cleveland Ohio  – Funding: Internal	– Design: (0) Small experiment+Cross-sectional observation – Facility/setting: (0) ED in a 1000 bed Academic Medical Center – Time period: (0) A) One day — Experiment: 8 syringe and 7 vacuum tube draws — no hemolysis observed. B) 10 days after education — 752 results observed C) 10 days immediately after removal of syringes and exclusive use of vacuum tubes (660 observations) and after elapse of 1.5 months (715 observations) – Population/Sample: (0) Adult ED patients requiring Potassium blood draws — all conducted using IV starts. – Comparator: (0) 1) For IV starts: syringe vs. vacuum tube – Study bias: (0) None observed — no control for patient characteristics, gauge of catheters, # tubes drawn, or staff conducting draw.	– Description: (0) Removal of syringes from ED forcing exclusive use of vacuum tubes. – Duration: (0) A) one day — 6/13/11 B) Training completed 6/13/11. Observed for 10 days C1) Syringes removed 7/14/11. Observed for 10 days. C2) 1.5 months later — observed for 10 days – Training: (0) One day (6/13/11) – Staff/other resources: (0) Minimal. – Cost: (0) Minimal.	– Description: (0) Hemolysis measured on all potassium samples using an automated analyzer. H index of ≥3 were considered hemolyzed. – Recording method: (0) Laboratory electronic information system results reviewed for relevant dates.	– Type of findings: (0) Rates of hemolysis – Findings/effect Size: (0) From observations before/after removal of syringes: Note: Baseline rate taken from period (B) with 752 observations. Effect rate take from period (C 1&2) with 660 and 715 observations For IV starts: syringe vs. vacuum tube 1) immediate after (N=660): 18.4% vs. 19.8% 2) at 1.5 months (N=715): 18.4% vs. 17.6% Other observations: Education — two 10 day periods before/after (752 observations after education): Hemolysis: 18.0% vs. 18.4% – Statistical significance/ test(s): (0) None done – Results/conclusion biases: (0) No bias observed. Based upon usual practice with isolated change. No major effects observed.
Quality rating: 10 (good)  Effect rating: Minimal/noneRelevance: Direct	Study (3 max): 3	Practice (2 max): 2	Outcome (2 max): 2	Results/findings (3 max): 3

^*Numbers in () by category headings reflect the number of points deducted from the maximum points for that column domain.